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Surprise medical billing emerges as prominent issue at the Capitol

Surprise out-of-network medical billing is emerging as a prominent issue within the Georgia General Assembly. A surprise medical bill can occur when a consumer encounters an out-of-network (OON) provider at an in-network facility or in other circumstances. Three pieces of legislation have been introduced to address surprise billing and each attempts to resolve the issue in its own way. In this week’s legislative update, we will provide a broad look at each bill and its provisions. (If you would like more information about any of the bills, click on the provided links to read the full legislation.) All three bills seek to protect patients, and we will monitor and weigh in on the bills as they undergo the inevitable amendment process in committee. We appreciate all of the bill sponsors for remaining vigilant towards protecting patients from unexpected medical bills.

HB 678 is sponsored by Rep. Richard Smith, chairman of the House Insurance Committee, and has the backing of several powerful House lawmakers. The bill improves transparency for consumers by outlining the information that must be provided to consumers by health care providers and practices and by insurers. Providers must inform consumers about their participation in the patient’s insurance network and about how to check the network status of other providers with which the primary provider has coordinated services (e.g. laboratory or radiology services). It also requires insurers to provide consumers with information about when and how to receive approval for services from an out of network provider. Insurers must also communicate to a consumer ahead of a planned procedure if the provider is out of network (OON), and if so, the estimated amount the insurer will cover for the OON services. Lastly, HB 678 provides consumers with 90 days from the time of receiving a medical bill to pay the bill, negotiate payment or initiate arbitration through the Georgia Department of Insurance. After that time period, providers would be allowed to initiate collection proceedings to secure their payment.

HB 799: Out of network care in emergency situations

While HB 678 applies only to non-emergency situations, HB 799 applies solely to emergency care and medically necessary follow-up care. The legislation, sponsored by Rep. Sharon Cooper, Chairperson of the House Health & Human Services Committee, disallows managed care plans from denying payment for emergency services and disallows hospitals from billing patients for medically necessary care following an emergency situation except for their standard co-pays, co-insurance, and deductibles. For a patient receiving emergency care at an OON hospital and who is covered by a plan that requires prior authorization for post-stabilization care, the legislation outlines how the OON hospital and insurer must coordinate the patient’s transfer to an in-network facility and defines which entities are responsible for specific costs. Under this bill, if a patient (or their representative) does not consent to be transferred to an in-network hospital, the OON hospital must provide verbal notice to the patient that they may be financially responsible for any further post-stabilization care provided.

SB 359: Consumer Coverage & Out of Network Medical Care Act

SB 359 is the only Senate-side legislation introduced thus far to address surprise out-of-network billing and is sponsored by Senator Chuck Hufstetler, Chairman of the Senate Finance and member of HHS committees. The legislation contains many of the same transparency provisions for non-emergency care as HB 678 with regard to information that health care providers and hospitals must supply to consumers, but provides for more robust disclosure by insurers to consumers about possible OON costs. It also contains provisions similar to that of HB 799 with respect to emergency situations, but goes farther to stipulate that insurers must treat OON emergency care as if it were in-network by applying a consumer’s cost-sharing towards their in-network deductible and out-of-pocket maximum. The legislation also makes mediation available to consumers who receive elective medical care during which an unexpected event arises resulting in surprise bill greater than $1000. SB 359 is expected to be more controversial than the other two bills because it sets a payment resolution process that sank previous legislative attempts.

RSVP today for Cover Georgia Day at the Capitol!

Join us next Thursday, February 15th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hard-working, low-income Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!

Can’t make it?Send an email to your state legislators asking them to put an insurance card in the pockets of all low-income Georgians.

Legislation prioritized by Senate leaders approved by HHS Committee

At Thursday’s Senate Health & Human Services Committee, the two pieces of legislation resulting from the Health Care Reform Task Force were considered. Both SB 357 and SB 352 received strong support from legislators and stakeholders. GHF’s partners at the Georgia Council on Substance Abuse and Mental Health America of Georgia rose in support of SB 352, which would create a 15-member Commission on Substance Abuse & Recovery supported by a director. Both bills were passed by unanimous voice votes. You can find a description of both bills in last week’s legislative update blog.

Georgians for a Healthy Future will be at the Capitol throughout the forty-day session to monitor health-related legislation, serve as a voice for health care consumers, and keep you informed about opportunities to engage and take action. For the past four years, our top legislative priority had been closing Georgia’s coverage gap by expanding Medicaid. In the wake of the 2016 election, the national policy landscape has shifted considerably, knocking that off the table this year and placing existing coverage, care, and consumer protections at risk. Despite this backdrop of uncertainty and a critical need for federal advocacy, there will be important decisions made over the next three months at the state level that impact the health of individuals, families, and communities.

While it is early, here are the major health care issues we preliminarily expect legislators to tackle in 2017:

Renewal of the provider fee commonly known as the “hospital tax” or “bed tax” to help fund Medicaid and keep hospital doors open

Development of a set of reforms to improve mental health services based on the recommendations of a legislative study committee that has been meeting over the past several months

Creation of a “repeal” task force to assess the impact of changes to or repeal of the Affordable Care Act on Georgia

Addressing the practice of surprise medical billing, which can leave insured consumers with unexpected bills when a health care provider is out-of-network

October is Breast Cancer awareness month and at Georgians for a Healthy Future we are committed to helping women access essential cancer screenings, including mammograms to detect breast cancer, through working to ensure that all Georgia women have access to health insurance. Uninsured, low-income women often face financial barriers to receiving recommended screenings for breast and cervical cancer and in Georgia, minority women face additional breast cancer disparities. However, research has shown that women who live in a state that has expanded Medicaid are more likely to get a mammogram than women that live in a non-expansion state. In 2008, women in every state had the same likelihood of getting a mammogram, but in 2015 a study found that women in expansion states were 25% more likely to get screened. As you can see, expanding Medicaid allows women to get the potentially life-saving preventive care they need. So for all the women in your life, please sign our petition to close the gap here.

As we approach the 2017 legislative session, we have the opportunity to close the coverage gap and ensure that some becomes all. Check out our new video about the Georgians stuck in the coverage gap and our opportunity to close it.

Today, we are asking that you be a part of the movement and contribute $25 to our Skincare reviews to close the coverage gap. Your contribution will allow us to travel across the state meeting with and raising up the voices of Georgians in the gap. It will fund our media efforts so that everyone, from Blueridge to Bainbridge, will know that these people can’t wait. The time to close the coverage gap is now.

Yesterday marked the start of a new chapter in the campaign to close the coverage gap. The Georgia Chamber of Commerce Health Access Task Force unveiled a set of proposals best beard trimmer to expand coverage. We are heartened that business leaders and health care industry stakeholders recognize the important role that coverage plays in a healthy and productive Georgia. You can read the news coverage in the AJC, WABE, Georgia Health News, and Atlanta Business Chronicle.

Is it a good plan?

We believe a coverage solution is one that extends coverage to all those Georgians caught in the coverage gap, does not erect unnecessary barriers to care, and maximizes the federal dollars set aside for Georgia. The Chamber’s proposal is a big step in this direction. While we have concerns about how some of the proposed provisions will impact consumers, we look forward to working with the Chamber, legislators, our Cover Georgia partners, and other stakeholders to find a solution that best serves individuals and families, our state’s health system, and our state’s economy.

What can I do to build on the momentum?

Be a part of the conversation! Your legislators need to know that this is an important issue for their constituents. Here you’ll find a quick and easy way to enter in your address and directly email both your state house and senate member. Let them know it’s time we close the coverage gap!

At Georgians for a Healthy Future, we’ve been fighting for expanded access to care since our doors first opened. We’ve developed videos and graphics to help simplify this complicated issue. We’ve created in-depth tools to explain the nuance and dispel myths. Our postcard and petition project has helped lift up this issue at the Gold Dome where we regularly testify and provide research to lawmakers.

As we get closer to closing the coverage gap we hope you’ll continue to stand with us. By signing up for the Georgia Health Action Network you’ll receive timely updates as the debate unfolds and easy ways for you to stay engaged. And, of course, we’re here for you! If you have questions about what’s going on, please ask!

Today the Georgia Chamber of Commerce released their proposal to address Georgia’s coverage gap, and expand access to health coverage for low-income Georgians.

Leaders of the Cover Georgia coalition responded with the following statements.
Cindy Zeldin, Executive Director of Georgians for a Healthy Future, a health care consumer advocacy organization that heads the Cover Georgia coalition said:

“We are encouraged that business leaders and health care industry stakeholders have prioritized health care coverage as a necessary component of economic vitality. The set of policy options put forth by the Georgia Chamber provides a strong starting point. We look forward to a statewide conversation in the coming months about the best approach to ensure all Georgians have a pathway to coverage and access to care.”

“We are encouraged that Georgia leaders are talking more than ever about the need to expand health care access and give the state’s health care system a timely boost. Closing the coverage gap is a smart investment for Georgia that would bring in billions of federal dollars and reduce uncompensated care costs.”

Tom Andrews, President of Mercy Care, a network of health clinics that provide primary care and support services to those who are homeless and uninsured said:

“On behalf of the 88% of our patients who are uninsured, we cannot adequately express the positive impact any one of these plans would have on the health of the patients we care for.”

Cover Georgia is a coalition of more than 70 organizations that have come together to educate the public, engage Georgia’s policy makers, and advocate to close Georgia’s coverage gap by expanding Medicaid. We believe a coverage solution is one that extends coverage to all those Georgians caught in the coverage gap, does not erect unnecessary barriers to care, and maximizes the federal dollars set aside for Georgia.

Tremendous progress has been made over the past three years in increasing enrollment into health insurance that facilitates access to care and provides financial protection for individuals and families across the state of Georgia. However, too many Georgians are still uninsured, the trends toward narrow networks and consolidation within the health industry threaten to negatively impact access to care, and consumers express concerns about affordability. Addressing these issues will require collaboration between enrollment and health care stakeholders, advocates, and policymakers. Here are three things Georgia lawmakers can do to ensure that all Georgians have access to the quality of care they need.

Close the coverage gap – Despite robust Marketplace enrollment in Georgia, we still have one of the highest uninsured rates in the nation, largely because our state policymakers have not yet closed the coverage gap. Georgia’s enrollment assisters have repeatedly expressed to advocates that this is the biggest barrier to enrollment that their consumers face.

Addressing Affordability – Rate review is an annual process during which insurance companies submit their proposed plan rates for the coming year to be reviewed by state and federal regulators. We encourage state regulators to scrutinize these rates closely to ensure they are justified and to request adjustments if they are not. We also encourage policymakers to explore emerging approaches in health care payment and delivery reform that hold the potential to enhance value for consumers.

For more details on policy and advocacy opportunities and our findings from research around the third open enrollment period, download our new report, Getting Georgia Covered: What We Can Learn from Consumer and Assister Experiences During the Third Open Enrollment Period.

Who doesn’t love to get mail? A hand-written note from a friend? An invitation to a wedding or surprise birthday party? A post-card from a family member enjoying their vacation in an exotic locale? Getting personal mail is not something that happens much this day and age, but still holds a lot of meaning to most people. If someone took the time to write you a letter to ask you to do something, wouldn’t that get your attention more than email? Now imagine that you got multiple letters asking you to do something from your friends, family members, and neighbors. That’s exactly what happened for a majority of Georgia’s state Senate and House members.

In July, Georgians for a Healthy Future mailed out stacks of post-cards to Georgia’s state legislators. These were not any post-cards. These were the postcards that GHF, with the help of the Cover Georgia Coalition, had been collecting over the past few years asking legislators to close the coverage gap. These postcards were signed by Georgians all across the state and were collected through outreach events, online petitions, and even Facebook ads. We collected more than 1100 postcards and sent them to legislators in every corner of the state. Many postcards included handwritten notes to their legislator asking them to close the coverage gap to help themselves, their family members, and fellow Georgians.

It’s not often that constituents are able to feel like they can directly communicate with their elected officials and this postcard project was intended to help give everyday people a voice for a topic that was important to them. More than 300,000 Georgians fall into the coverage gap and are unable to get affordable health insurance. Often these Georgians go without coverage and regular medical care. Many Georgians want to fix this issue and took the time to let their legislators know that they support closing the coverage gap. These postcards will have an impact as state legislators hear from their constituents that they want all Georgians have access to quality, affordable health insurance.

We will continue collecting postcards and sending them to legislators as we get them. If you haven’t signed a postcard yet, you can still do so by signing our online petition.

It’s been an exciting few weeks for Close the Gap advocates. We are pleased to see that several of Georgia’s leaders have expressed to the press that they are willing to take a second look at closing Georgia’s coverage gap. By closing the gap, they would help not only hard-working Georgians but also struggling rural hospitals and the communities that rely on them. We hope to work with our state leaders in the coming months to build further support and to find a solution that works for all Georgians. Below you’ll find links to articles covering the conversation happening at the Gold Dome.

Email your legislator and tell them you support closing the coverage gap!

Did you know that you can find and email your legislators right from the GHF website? Just enter your address and we’ll find your state representative and senator! Send them a brief email telling them that the time has come for our legislature to come together to close Georgia’s coverage gap! Send your email here.

Need more resources on the coverage gap?

These resources will help you understand what the coverage gap is and what it means for you and the state.

Ebenezer Baptist Church is a cornerstone of advocacy and social justice in Atlanta. On June 20th, Laura Colbert, Director of Outreach & Partnerships, was invited to join their Women’s Season celebrations to talk about the importance of closing Georgia’s coverage gap. She spoke to a crowd of about 60 women on a day when the theme was health and self-care.

In keeping with the theme, Laura discussed how the women and parents in Georgia’s coverage gap are often unable to access health care so that they can better care for themselves and their families. She also highlighted the connection between health care coverage and better financial health—an important consideration for the low-income Georgians stuck in the coverage gap. Finally, she highlighted that parents who have health care coverage are more likely to keep their kids covered too.

At the end of Laura’s time, Ebeneezer women signed coverage gap postcards to let their legislators know that they support closing the coverage gap. If you haven’t done the same yet, click here to raise your voice and let your legislators know that this is an important issue that you want addressed.